Su W P
Department of Dermatology, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1997 Mar;72(3):267-72. doi: 10.4065/72.3.267.
To provide an overview of the clinicopathologic correlation of the various types of malignant melanoma, we describe and illustrate the four major types of these tumors and discuss the concept of microstaging for the prognostic evaluation of melanoma. The four major types of malignant melanoma are lentigo maligna melanoma, acral lentiginous melanoma, superficial spreading melanoma, and nodular melanoma. Lentigo maligna melanoma has irregular margins and usually occurs on sunlight-exposed skin in elderly patients. Acral lentiginous melanoma occurs on the hands and feet; it often demonstrates massive invasion when the vertical growth phase occurs. Among Caucasians, superficial spreading melanoma, which affects the trunk and extremities, is the most common malignant melanoma. These lesions are often variegated in color. Nodular melanomas are deeply pigmented and enlarge rapidly. For microstaging of malignant melanoma, determining Clark's level of tumor invasion or Breslow's thickness (from the top of the granular cell layer of the epidermis to the deepest extension of the tumor) is useful for assessment of prognosis. Establishing a definite diagnosis of malignant melanoma is feasible through clinicopathologic correlation. Microscopic measurement of the deepest levels of melanoma involvement in the skin provides a useful indication of the associated prognosis.
为了概述各种类型恶性黑色素瘤的临床病理相关性，我们描述并展示了这些肿瘤的四种主要类型，并讨论了用于黑色素瘤预后评估的微分期概念。恶性黑色素瘤的四种主要类型为恶性雀斑样痣黑色素瘤、肢端雀斑样痣黑色素瘤、浅表扩散性黑色素瘤和结节性黑色素瘤。恶性雀斑样痣黑色素瘤边缘不规则，通常发生于老年患者阳光暴露部位的皮肤。肢端雀斑样痣黑色素瘤发生于手和足部；在垂直生长期常表现为广泛浸润。在白种人中，影响躯干和四肢的浅表扩散性黑色素瘤是最常见的恶性黑色素瘤。这些病变颜色常呈斑驳状。结节性黑色素瘤色素沉着深且生长迅速。对于恶性黑色素瘤的微分期，确定克拉克肿瘤浸润水平或布雷斯洛厚度（从表皮颗粒层顶部至肿瘤最深浸润处）有助于评估预后。通过临床病理相关性建立恶性黑色素瘤的明确诊断是可行的。对皮肤中黑色素瘤累及最深层面的显微镜测量可为相关预后提供有用的指示。
